FROM THE MAYO CLINIC.

Exercise on repaired knees, but take it very easy at first

November 20, 2005|By Tribune Media Services.

Q. I'm 48 years old, overweight and very out of shape. I had knee-repair surgery about two years ago and have never fully recovered. I want to exercise, but most activities hurt my knees. Could you make some suggestions of how to get started with an exercise program?

--Grand Forks, N.D.

A. Because of your knee pain, I'd suggest you start by enlisting some help. Schedule an evaluation with an orthopedist or physical-medicine and rehabilitation physician, who can recommend exercises to help strengthen your knees and minimize pain. You'll also learn how to care for your knees during and after exercise, by wearing a brace or applying ice.

I'd also recommend that you work with a physical therapist or personal trainer to get started. It's important that you exercise and use gym equipment correctly and safely to avoid injury to your knee.

Working with your therapist or trainer, write down your goals and a plan. Be realistic. Start small and gradually increase the time and effort you expend. Most people start too hard, get discouraged or sore and lose motivation. Ideally, you'll eventually want to do aerobic activities that get your heart rate up three or four times a week and strength-training two or three times a week. Your plan will likely include:

Aquatic exercise: Walking in the water, water aerobics or swimming can help you build strength and cardiovascular fitness. These activities also are easy on the knees. (One caveat: If you are trying to lose weight, aquatic exercise doesn't seem to help weight loss as much as other types of exercise.)

Non-impact aerobics: Stair steppers, elliptical trainers, bicycling and stationary bicycles are generally well tolerated and are good options.

Low-impact aerobics: As your knee strengthens, you can advance to walking on a treadmill or outside.

It's great that you are ready to increase your physical activity. If you regularly do aerobic and strengthening activities, your program can help with weight loss as well as reduce the risk of heart disease, diabetes, hypertension and some cancers. An added benefit: Your knee will likely feel better too.

If you've started waking up with the birds--or even before the birds--you may not be getting enough sleep.

With age, changes in your sleep pattern, health and lifestyle may contribute to sleep difficulties, such as extra-early rising. Even so, you still require about the same amount of sleep as you did in the past. The amount of sleep needed varies from person to person; seven to eight hours per night is average.

Identifying and treating the causes of sleepless or restless nights may help you get the amount and quality of sleep you need. Three common changes during aging can affect sleep:

Normal changes in sleep patterns: As you age, you spend more time in lighter sleep. The clock in your brain speeds up, creating the desire to go to bed earlier, so you wake up earlier too. Try to resist the urge to retire early. Spending time outdoors in the evening can help you stay alert longer.

Changes in activity: Physical or social activity promotes a good night's sleep. Being less active can affect sleep.

Changes in health: Chronic pain, depression, stress, hot flashes or the need to urinate frequently can disrupt sleep. So can some medications, nicotine and alcohol.

In some cases, simple lifestyle changes may result in better sleep. Limit time in bed to when you're sleeping. Avoid naps or limit them to no longer than 30 minutes. Exercise but not too close to bedtime. Limit caffeine and alcohol, and stop using nicotine.

If you feel rested and alert during the day, you're probably getting enough sleep. If you're fatigued or it's hard to concentrate, take action to reclaim a good night's sleep. If simple changes don't help, ask your doctor for advice.